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I <br /> �I <br /> Date � � t"� ,�� PutJ¢WorksPar , <br /> r ��- -�� 7v,� <br /> r�pplication For eia9.neo�.� <br /> PUBLIC WORKS PERMIT PublicWorksfee <br /> .o�a�;aa $ <br /> Less Pvol.Fee Paia 5 . <br /> Balance Duu $ <br /> Print or Type Only <br /> S���v�n `�"C�� , /�I�/0� —�D��'��U2° GfJ �/LY �,��� _ �f� I�' <br /> Owner Mailing Address City Zip hone L�arCj'�/n <br /> `.,7_ <br /> S�vrrc.,/ 77/-io7D <br /> qpplicant Mailing Address Ciry Zip Phone <br /> Describe P�opcsed Work / ' ` • <br /> � o .s�_ ��,�.��� � W <br /> Prolect Address(if known) � <br /> Attach lou. (4) copies of plans for proposed work- Draw to scale and note the following as applicable: s <br /> • Property Li��es • Cen�erline of street /^ <br /> • OuUine and dimensions of all existing and • InAicale North �� <br /> proposed structu:es on the lot • Show any proposed grad:�g changes <br /> • Existing and proposed u�ili�ies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. ^ <br /> 2.All work shall be peAormetl in acwrdance with this permil and current Ciry of Everett Design anA Construclion � <br /> Standards and Specifications � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-(300•424-5555. � <br /> / L��I.CJ LCI�7/.? �—C��'ih'L.GrI ,V(I� �Lk�,'�/�GGf� 7I <br /> � � <br /> `���y_8 9�� � � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF�CONDITIONS <br /> Th,:undersigned owner/applicant hereby agrees to hold and save harm- <br /> -- less ihe City ol Everett trom any and �dl daims for damages, cusls. <br /> expenses, or causes of action that map arise because of installation <br /> anA meinten3nce of ihe improvemenl a� olher rigM�ohway use hereto <br /> _. __ �ppfed for and further agrees fo remove same upon notice from Ihe ' <br /> Approve.'iur CocsVu�.tion �31e Cit;and to replar,e public property damaged ihereby <br /> FINAL INSPECTION Cat� — <br /> Approved as Constructed SignaWre of Applicant Date <br /> � PUBLICWORKSDEPARTMENT ' 'ORK AUTHORIZED BY TIiIS PERMIT MUST BE SfARTED WITHIN <br /> 'y� 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> ilE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> � Everett,WA 98201 i;qitiCELLED BY THE CITV UPON ANY STOPPAGE OF NOfiK ON THIS <br /> Phone:259�8[310 P�70JECT OVER 90 DA Y S D U R ATION. <br />